Another meeting on clinical governance and yet again it is surgeons who are cast as the main villains by purchasers, managers, and even fellow clinicians. Since surgery is the only discipline where it is easy to measure outcome all discussion on this topic seems to revert to surgery. I ought to be used to the charge of being an élitist megalomaniac. After all I am a neurosurgeon, and everyone knows that the only difference between God and a neurosurgeon is that God does not want to be a neurosurgeon. However, I do not think that I fit this caricature. What is it that really motivates me and my colleagues?

For me, surgery has always been a vocation. I have been able to accept the responsibility of operating only by setting myself the highest standards. Of course, resources are limited, but I used to be proud to be part of a system that allowed for ideals other than personal financial gain. To be a …